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Injecting Drug Users’ Prevent Overdose

Thursday, 9 July 2015

Injecting drug users are helping to prevent overdose with training and support from the WA Substance Users' Association (WASUA), a not-for-profit organisation that offers health services, including needle and syringe exchange, to people who use drugs in Western Australia.

The Overdose Prevention and Management (OPAM) program aims to reduce the physical and psychological harms associated with illicit drug use, with a focus on preventing and managing opioid or poly-drug central-nervous-system (CNS) depressant overdose, and on preventing and responding appropriately to amphetamine toxicity.

According to WASUA's Overdose Prevention and Naloxone Program Project Officer Laura Jinks, the project builds on the strengths of the local drug user community to improve health outcomes.

"In any community there are lines of communication and we want to use those lines of communication to share harm reduction information," says Laura.

Opportunity to Prevent Overdose

Roughly 40% of fatal overdoses occur when no one else is around. In the other 60% of cases, the people present may not be aware that the person is overdosing, or they may not know how to respond as a first-aider.

"That 60% we endeavour to train up to respond and manage the situation," says Laura. "We change the ethos of people using drugs and give them strategies to reduce the harm of using on your own."

Overdose-Related Harm

An overdose doesn't have to be fatal to cause serious harm. In opioid-related overdose, the part of the brain responsible for breathing is impaired. Lack of oxygen can then cause damage to the brain or other parts of the body before the person comes round.

An overdose also affects the people who witness it.

"When you're overdosing you usually don't realise it," says Laura. "However, it can be an extremely scary, terrifying experience for anyone who witnesses an overdose."

WASUA's Laura Jinks says peer educators care about their community

Why Do People Step Forward To Be Peer Educators?

Most people who choose to learn more about the program want to be able to help.

"I think people have this perception that people who use drugs are just in it for themselves, that we're outside of the general community," says Laura. "But really, people who use drugs are just like anyone else - we care about our community, about our friends and about our family."

Laura says that witnessing an overdose can motivate people to participate.

"They want to be skilled up so they can help if it happens again."

Who Can Be A Peer Educator?

The OPAM project recruits people from the Perth metropolitan area who regularly inject or use opioids. To reach a wider group, this criteria has expanded to encompass users who have a wide social network of people who may inject drugs other than opioids. These people are trained and supported to be peer educators.

"We hold focus groups and chat to everyone," says Laura. "We're careful not to lead them and, because people do get reimbursed for time and experience, we make sure they're in it for the right reasons."

"We'd much rather have a smaller group than have people involved who perhaps aren't ready or aren't suited to the role."

What Do Peer Educators Learn?

Peer educators take a two-day training course to prepare them for the role. The first day of the course covers harm reduction techniques such as using sterile equipment and cleaning the injecting site.

"We're just arming them with a bit more knowledge," says Laura. "We talk about why this is so important… what are the effects of not filtering, for example… what's the best thing to do, and what's the next best thing to do if you can't do that?"

Participants are taught first aid, and earn a basic life support certificate on the second day of training.

Once participants have completed the peer educator training, they are provided with a diary to record times when they've been able to offer information to their peers. The diary includes useful contact information for other sources of health information, such as the WA AIDS Council, Next Step Drug and Alcohol Service and the Aboriginal Alcohol and Drug Service.

Peer educators are also encouraged to attend an additional day of training to cover the use of naloxone to manage overdose.

Naloxone (or "Narcan") is the drug used by paramedics and hospitals to reverse opioid overdose. WASUA Peer-administered Naloxone Project trains people to recognise and manage overdoses, and in how and when to administer naloxone. People who complete this training can be prescribed and dispensed naloxone kits for free.

How Do They Share What They Know?

Peer educators share what they know during normal conversation with people who inject drugs, people who are social or casual contacts.

"Peers are there while people are using drugs and they're able to share information about safer injecting and safer drug use," says Laura. "Sometimes the challenge is for peer educators to recognise that what they're doing is education and that it's helping others. Peers are also in an ideal position to recognise and respond to overdoses promptly."

OPAM peer-educators have successfully resuscitated many people who may otherwise have died or suffered permanent injury before an ambulance could arrive.

"We hammer it home that it's by users for users… it's not a tokenistic involvement, we get their feedback in the diaries and we use that when we revise and reprint them," says Laura. "The peer-educators have helped design educational resources as well."

For six months after the training sessions, peer educators note down any instances in which they've had the opportunity to share what they know. This provides useful information about their work, about the health issues faced by drug users, and about changing trends in the community.

They also note down any questions they've been asked but couldn't answer.

"We tell people, 'if you don't know, don't guess' and when they come in we might work with them to find out the answer, we do the research together," says Laura.

Benefits to the Community and Health Services like WASUA

Peer educators have a great deal of knowledge about what's happening among their networks, which helps WASUA to offer health information and services that meet the community's current needs.

"We're very respectful of experiences… their voices are heard," says Laura. "For example, peer educators might come in and say 'a lot of my friends are getting abscesses', so we'll put information up on the board in the exchange and we discuss it with clients or hand out information related to that."

Peer educators also come into contact with people who don't access health services or needle and syringe exchange programs (NSEPs), such as those offered by WASUA.

"Especially in outer suburbs or outside the metro area, people are often buying their injecting equipment from pharmacies, or given syringes by friends or the person they buy their drugs from, but don't have access to health information or referrals," says Laura. "Peer educators disseminate harm reduction education and broaden the referral base for WASUA and other AOD agencies."

"That's one part of the project that I find really savvy… this gives us an avenue to get information to people who don't access services directly."

Benefits for Peer Educators

"Man, I went from being a street urchin to being a teacher… …this knowledge I have is worth something and I help people…" OPAM Peer Educator.

Peer educators are reimbursed for their time and expertise but the rewards go beyond a little extra cash or a free lunch.

"We pay them to attend a de-briefing session and take them out to lunch," says Laura. "One of the guys went out and bought a skateboard during the break so he could show us, two boys saw a two-for-one shoe sale at the nearby sport store so pooled their money and bought a pair of shoes each, while another guy went out and bought his son a Christmas present… …even I've been pleasantly surprised."

The OPAM project has been so successful that some peer educators volunteer to continue once their six months is up.

"We actually have a lot of people who volunteer to carry on unpaid, people who want to make a difference," says Laura.

"They feel more empowered, more educated, more competent, more confident - it's a common theme, and it speaks volumes that they want to volunteer later."

More Information

For more information about the Overdose Prevention and Management (OPAM)
program or the Peer-administered Naloxone Program, please call the WA Substance Users Association (WASUA) on (08) 9321 2877 or call in to WASUA at 519 Murray Street, Perth.

The
Overdose Prevention and Management (OPAM) program is a collaborative
project of WASUA and the WA Drug and Alcohol Office (now Mental Health
Commission).